“Infertility does not always begin with waiting and waiting without falling pregnant. Sometimes the first signs appear in the menstrual cycle itself, in the skin, or in very small changes in the body.”
Infertility in women can be linked to many factors, such as ovulation disorders, polycystic ovary syndrome (PCOS), endometriosis, endocrine disorders or abnormalities of the uterus and fallopian tubes.
Some cases have fairly clear signs, while other women have no particular symptoms until they run into difficulty becoming pregnant.
Recognising unusual changes in the body is therefore not about self-diagnosing infertility, but about helping women know when to take the initiative and have their reproductive health checked.
Below are 6 signs of infertility in women that you should not ignore.
1. Irregular Periods
🩸 The menstrual cycle is one of the important signs reflecting how the reproductive system and ovulation are working.
You should pay attention if you often experience:
- Cycles shorter than 21 days.
- Cycles lasting more than 35 days.
- Large variation in the gap between periods.
- Frequently missed periods.
- Cycles that are hard to predict for several months in a row.
According to the American Society for Reproductive Medicine (ASRM), in most women who ovulate normally the menstrual cycle is relatively regular and falls within 21–35 days. Cycles shorter than 21 days, longer than 35 days or varying considerably are factors that need further assessment.
Irregular periods may be linked to:
🔹 Polycystic ovary syndrome (PCOS)
🔹 Thyroid disorders
🔹 Raised prolactin
🔹 Weight changes
🔹 Exercise at excessively high intensity
🔹 Certain disorders of ovarian function
This does not mean that irregular periods always signify infertility. However, if the situation repeats itself over a long period, especially when you are hoping to conceive, it is a sign that should be checked.
2. Amenorrhoea – No Periods For Several Months
📅 A prolonged absence of periods while you are not pregnant is also something to take note of.
According to ASRM, secondary amenorrhoea should be assessed when:
- There have been no periods for more than 3 months in someone whose cycles were previously regular.
- There have been no periods for about 6 months in someone whose cycles were already irregular.
Some possible causes of amenorrhoea include:
🔹 PCOS
🔹 Raised prolactin
🔹 Thyroid disorders
🔹 Disorders of hypothalamic–pituitary activity
🔹 Declining ovarian function
🔹 Significant weight changes
🔹 Energy deficiency from dieting or excessive exercise
When ovulation is interrupted over a long period, the chance of conceiving naturally may also be affected.
However, amenorrhoea does not mean the ovaries have “stopped working”. The cause may lie at various points in the hormone regulation system and needs to be assessed in detail by a doctor.
3. Severe Period Pain Or Pain During Intercourse
🌷 Mild pain in the first days of a period is fairly common. But if every period comes with pain severe enough to affect your work, your sleep or your daily life, you should not treat it as something “every woman just has to put up with”.
Some notable signs include:
- Severe pelvic pain before or during a period.
- Pain lasting several days.
- Deep pain during sexual intercourse.
- Recurring pelvic pain outside of periods.
- Pain that grows worse over time.
One of the causes that needs to be considered is endometriosis.
According to the American College of Obstetricians and Gynecologists (ACOG), persistent pelvic pain, significant pain before or during a period and pain during intercourse can all occur in people with endometriosis. The inflammation, scarring and adhesions caused by the condition can affect the fallopian tubes, the egg or the movement of sperm.
However, pain during intercourse can also be linked to many other causes, such as:
🔹 Ovarian cysts
🔹 Pelvic inflammation
🔹 Vaginitis
🔹 Pelvic muscle spasm
🔹 Certain other gynaecological conditions
ACOG recommends that if pain during intercourse happens frequently or is severe, women should be examined to find the cause.
4. Persistent Acne, Excess Hair Growth Or Unusual Hair Loss
🧬 Changes in the skin and hair are sometimes about more than appearance.
If you have all of the following at the same time:
- Persistent acne in adulthood.
- Heavy hair growth on the chin, face, chest or abdomen.
- Thinning hair on the crown of the head or heavy hair loss.
- Infrequent or irregular periods.
- Weight gain or difficulty controlling your weight.
… then it may be worth being checked for an androgen hormone imbalance.
One of the common causes is polycystic ovary syndrome – PCOS.
According to the National Institute of Child Health and Human Development (NICHD), PCOS can cause:
🔹 Absent or irregular ovulation
🔹 Irregular periods or absent periods
🔹 Excess hair growth
🔹 Long-lasting acne
🔹 Weight gain or difficulty losing weight
🔹 Difficulty becoming pregnant
NICHD also records PCOS as one of the common causes of infertility due to a lack of ovulation.
However:
👉 Having acne or excess hair growth does not mean you definitely have PCOS.
Diagnosis needs to be based on several factors, such as menstrual history, signs of raised androgens, tests and other specialist assessments.
5. Unusual Milky Discharge When Not Pregnant Or Breastfeeding
💧 If your nipples produce a milk-like discharge while you are not pregnant and not breastfeeding, this is a sign worth discussing with a doctor.
One possible related cause is a raised prolactin hormone level.
Prolactin is the hormone involved in producing breast milk. When prolactin levels rise abnormally, the reproductive hormone system can be affected, leading to:
🔹 Infrequent periods
🔹 Absent periods
🔹 Ovulation disorders
🔹 Difficulty becoming pregnant
ASRM states that raised prolactin is one of the common causes of menstrual disorders and amenorrhoea. However, not everyone with high prolactin develops unusual milky discharge.
Conversely, nipple discharge is not always caused by prolactin.
If the discharge:
🚩 Contains blood
🚩 Appears on one side only
🚩 Comes with an unusual lump in the breast
🚩 Comes with changes to the skin or nipple
… you should be examined promptly to rule out conditions of the breast tissue.
6. Unusual Weight Changes
⚖️ Weight and fertility are quite closely connected through the hormone system that controls ovulation.
You should pay attention if:
- You gain a significant amount of weight in a short time.
- You lose weight rapidly for no clear reason.
- You diet excessively.
- You are often low on energy.
- You train at a very high intensity.
- Your weight changes at the same time as your periods become irregular.
ASRM records that weight gain, weight loss, obesity, excessive exercise, thyroid disorders and raised prolactin can all be linked to ovulatory dysfunction.
In people with PCOS in particular, weight gain or difficulty losing weight can also appear alongside irregular periods and signs of raised androgens.
Even so, you should not assume that losing weight is the way to treat infertility.
If your weight changes rapidly or unusually, what matters more is finding the cause and getting advice on a diet and exercise plan suited to your state of health.
You Can Still Have Infertility Without These 6 Signs
🌿 This is something many women easily overlook.
You may still:
✔️ Have regular periods every month
✔️ Have no period pain
✔️ Have no acne or excess hair growth
✔️ Have no clear abnormal signs
… but still have difficulty becoming pregnant.
The reason is that fertility does not depend only on whether or not you have periods.
Some other factors may be involved:
- The condition of the fallopian tubes.
- The structure of the uterus.
- Ovarian reserve.
- Reproductive age.
- A history of pelvic surgery or pelvic disease.
- Fertility factors in your partner.
ASRM recommends that an infertility assessment should look at ovulation and the structure and patency of the female reproductive tract, as well as assessing the male factor where appropriate.
Therefore, having no symptoms does not mean your fertility is definitely normal.
When Should Women Have An Infertility Check-Up?
👩⚕️ Not every woman needs to wait a very long time before having her fertility checked.
According to ASRM:
Women under 35
Should begin an infertility assessment if they have had regular intercourse without contraception for about 12 months but have not become pregnant.
Women aged 35 and over
Should be assessed after about 6 months of trying to conceive without success.
Women over 40
Fertility assessment may need to be carried out sooner, rather than continuing to wait.
You also do not necessarily have to wait a full 6–12 months if you already have factors that could affect fertility, such as:
🚩 Very irregular or absent periods
🚩 A history of endometriosis
🚩 A history of pelvic disease or pelvic surgery
🚩 A previous illness affecting the ovaries
🚩 Previous chemotherapy or radiotherapy
🚩 A previously diagnosed reproductive health abnormality
ASRM recommends beginning the assessment early if there is a medical history known to be associated with infertility.
What Does An Infertility Check-Up For Women Usually Involve?
🔬 There is no single “infertility test combo” that is the same for every woman.
Depending on age, menstrual cycle, health history and how long you have been hoping to conceive, a doctor may order:
📋 A review of the menstrual cycle and obstetric and gynaecological history
📋 A gynaecological examination
📋 Ultrasound of the uterus and ovaries
📋 Assessment of ovulation
📋 Hormone tests when indicated
📋 Thyroid function tests where appropriate
📋 Assessment of ovarian reserve when needed
📋 Checks on the structure of the uterus and the patency of the fallopian tubes
One important point is that not every test needs to be done right at the start.
For example, ASRM notes that ovarian reserve testing should not be used as a mass screening test in women who do not yet meet the criteria for infertility; it is mainly a supporting tool during assessment when indicated.
Do These 6 Signs Mean You Are Infertile?
❌ No.
Irregular periods, absent periods, period pain, excess hair growth, unusual milky discharge or weight changes can all be linked to many different health conditions.
They should be seen as signals worth paying attention to, not as criteria for concluding on your own that you are infertile.
Conversely, if the signs persist, appear together, or you have been hoping to conceive for some time without becoming pregnant, an examination can help to:
✔️ Identify the cause of menstrual or ovulation disorders
✔️ Detect gynaecological conditions that may affect fertility
✔️ Assess the health of the uterus, ovaries and fallopian tubes when needed
✔️ Set up a more suitable plan for monitoring reproductive health
Do Not Wait Until You Have Been Hoping For A Baby Too Long To Think About Your Reproductive Health
🌱 The body sometimes sends signals very early.
A menstrual cycle that becomes more and more irregular.
Period pain that becomes more and more severe.
Acne and excess hair growth appearing along with absent periods.
Or an unusual change you have grown so used to that you think “it is probably nothing”.
Not every sign is related to infertility.
But when these changes persist or clearly affect your body, an early check-up helps you understand exactly what is happening instead of guessing for yourself.
📱 With Halza, you can:
✔️ Search for suitable hospitals and clinics
✔️ Book Obstetrics and Gynaecology and reproductive health appointments conveniently
✔️ Store test results, ultrasound scans and consultation records
✔️ Track your health records on a single platform
Understanding your body early is one way to take more control of your own reproductive health.
References
📚 American Society for Reproductive Medicine (ASRM) – Fertility Evaluation of Infertile Women
📚 American Society for Reproductive Medicine (ASRM) – Current Evaluation of Amenorrhea
📚 American College of Obstetricians and Gynecologists (ACOG) – Endometriosis
📚 American College of Obstetricians and Gynecologists (ACOG) – When Sex Is Painful
📚 Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD/NIH) – Polycystic Ovary Syndrome
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